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Individual

SURENDER VUTHOORI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
63532 29 PALMS HWY, STE A, JOSHUA TREE, CA 92252
(760) 366-8491
(760) 346-2471
Mailing address
PO BOX 168, 6353229 PALMS HWY STE A, JOSHUA TREE, CA 92252
(760) 366-8491
(760) 346-2471

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A33804
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A338040
BLUE SHIELD
CA
05
00A338040
CA
05
00A338041
CA
01
756061629
RAILROAD MEDICARE NUMBER
CA
01
953529571
BLUE CROSS
CA
Enumeration date
02/02/2007
Last updated
05/20/2009
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